Recognition of Bacteria and Bacterial Products by Host Immune Cells in Sepsis

  • J. Pugin
Part of the Yearbook of Intensive Care and Emergency Medicine book series (YEARBOOK, volume 1996)

Abstract

Bacterial sepsis is the leading cause of death in non-coronary intensive care units, and accounts for over 200000 deaths per year in the United States of America [1]. In critically ill patients with a suspected or a proven source of infection, sepsis is characterized by physiological disturbances such as fever or hypothermia, tachycardia, tachypnea, leukocytosis or leukopenia [2, 3]. Severe sepsis is defined by the same condition with evidence of organ dysfunction. Patients in septic shock meet the criteria of severe sepsis with in addition presence of hypotension refractory to volume loading [2]. The condition of physiological disturbances such as in sepsis, but in the absence of infection, is known as “systemic inflammatory response syndrome” (SIRS) [4]. These new definitions of sepsis and related infectious syndromes in critically ill patients underline the trend towards a pathogenic definition of these conditions. Indeed, those definitions reflect the will of clinicians to recenter the disease on host responses, rather than on the triggering infectious microorganism. This is supported by clinical and basic researchers who also recently realized that the pathogenesis of bacterial sepsis depended on host responses rather than on the infectious process [5]. It has recently become clear that bacterial infections initiate host responses through activation of biochemical and cellular cascades, leading to the production of effector immune cells and of endogenous mediators [1, 6, 7]. This response is often adequate and necessary for a rapid immune response directed against the invading microorganism. However, in some cases, this response is inadequate and deleterious for the host himself, and causes the syndrome known as severe sepsis.

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© Springer-Verlag Berlin Heidelberg 1996

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  • J. Pugin

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